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Prognostic utility of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI)

Jonathan S Ilgen1, Alex F Manini, Udo Hoffmann

  • 1Division of Emergency Medicine, University of Washington School of Medicine, Harborview Medical Centre, 325 9th Avenue, Box 325709, Seattle, WA 98104, USA. ilgen@uw.edu.

International Journal of Emergency Medicine
|August 2, 2011
PubMed

Insights

The acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) shows limited ability to predict major adverse cardiac events (MACE). However, a low ACI-TIPI score may help identify patients with acute chest pain suitable for safe outpatient management.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Test Evaluation

Background:

  • Patients presenting to the Emergency Department with symptoms of acute coronary syndrome (ACS) require accurate risk stratification.
  • The acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) is a tool used to assess cardiac risk.
  • Evaluating the test characteristics of ACI-TIPI for major adverse cardiac events (MACE) is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate the diagnostic test characteristics of the ACI-TIPI for predicting 30-day MACE in Emergency Department patients with symptoms suggestive of ACS.
  • To examine the performance of various dichotomous cut points of the ACI-TIPI score.

Main Methods:

  • A prospective cohort study was conducted with 144 Emergency Department patients presenting with acute chest pain.
  • Baseline demographics, cardiac risk factors, and electrocardiogram (ECG) data were collected.
  • The ACI-TIPI probability score was calculated, and its diagnostic accuracy for 30-day MACE (including NSTEMI, PCI, CABG, and all-cause mortality) was determined.

Main Results:

  • Of 144 patients, 19 (13%) experienced MACE within 30 days.
  • The ACI-TIPI demonstrated a c-statistic of 0.69 (95% CI 0.59-0.80), indicating limited overall discriminatory value.
  • An ACI-TIPI score of ≥ 20 achieved 100% sensitivity and 100% negative predictive value, but only 21% specificity for MACE.

Conclusions:

  • The ACI-TIPI has limited discriminatory power for overall MACE in this cohort.
  • A low ACI-TIPI score (< 20) may possess prognostic utility for safely managing patients with acute chest pain as outpatients.
  • Further validation is needed to confirm the role of ACI-TIPI in guiding outpatient management decisions.
Abstract

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